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Comment author: hyporational 02 February 2014 03:12:09AM *  1 point [-]

Substitute depression with pain or fatigue for example. We can't directly measure these either, so what's the crucial difference?

In a nutshell, we diagnose patients based on their behaviour, not their brain chemistry and function, while we are using medication to treat their brain chemistry and function.

We diagnose high blood pressure by measuring the patient's blood pressure, not the relevant biochemistry we're going to treat with blood pressure medication. Do you see a similar problem with that?

Looking at the side effects for many psychiatric medications, it is fairly clear that the side-effects are vast and for a huge number also include non-temporary worsening of symptoms, including risk of suicide. To me that indicates that we do not understand nearly enough about brain chemistry or the cause of mental illness to medicate with reason - as much of it is intuition and experience and guesswork as formal training.

Evidence, please, not random blog articles. Side effects are common, nobody's going to deny that. Non-temporary worsening of symptoms doesn't sound like a common side effect. Like with any medication, some cost-benefit analysis has to be done.

Pretty much all medications have side effects. In what kinds of situations do side effects start to indicate lack of reason?

we don't really know what is wrong with people suffering from depression but looking at the symptoms we get a good idea of where the fault could lie within the brain

We arguably don't really understand pain extremely well either. We know how to treat it however. Is there any reason why we shouldn't?

Furthermore, major theories such as that the serotonin causes depression are suggested to be simplistic and innacurate, so while we have an idea that using medication to affect serotonin levels can help depression, it doesn't mean that low serotonin levels are the cause.

That's a common strawman. There are a variety of hypotheses these days and some simplistic serotonin imbalance isn't one of them. One of the reasons this simplistic hypothesis doesn't work is that the medications work with a delay, although they immediately raise serotonin levels in the relevant synapses. I'm pretty sure this has been known about as long as these kinds of medications have existed. There's a lot of diseases we don't understand but know how to treat, most of them not psychiatric. Lack of complete understanding is a poor reason to deny treatment from people.

depression is probably the most studied mental illness (if not one of), if our understanding of that illness is vague, it seems likely that our understanding of other psychiatric illnesses are too (which is supported very much by the "we'll try this medication and see if it works" approach, as opposed to "you have a hole in your leg, we'll dose you up with morphine and you won't feel it as much")

The understanding is probably a lot less vague than you think, and vagueness of understanding isn't a sufficient reason not to treat a condition if the treatment is known to work like in this case. Most medical conditions are vague compared to a hole in the leg, so that juxtaposition doesn't illustrate much.

Comment author: aletheianink 09 February 2014 08:02:59AM 0 points [-]

I was going to reply to your direct examples, but an overarching response seems more appropriate.

I am not saying we should not medicate, as you seem to think. As a long-term psychiatric patient and the wife to another, I have seen the enormous benefits medication for depression can bring. I am saying that our understanding of this condition is relatively basic in regards to its complexity. A hole in the leg, or pain, do not need to be complexly understood to be dealth with sufficiently - pain medication hides the pain, that is the goal, and a suitable painkiller will do the job. It does not fix the hole in the leg, or the source of the pain.

With depression, the symptoms are treated, not the cause. Which is not a bad thing in itself, but it does not cure someone of their condition, which would be an ideal long-term goal. Painkillers are no use to a patient if the doctor cannot fix the wound or it cannot be healed; likewise with depression.

In regards to your association that "Non-temporary worsening of symptoms doesn't sound like a common side effect.": Sertraline (zoloft): depression is a "common" side effect affecting more than 1 in 100 people Citalopram: more than 1 in 100 people experience anxiousness, nervousness, apathy (which can be a symptom of depression for some) while (uncommon) more than 1 in 1000 experience aggressive behvaiour or mania (i.e. the medication could trigger a manic episode in a bipolar patient diagnosed purely with depression, highlighting my point about a diagnosis being based on behaviour)

My point is not, as you seem to think "we don't understand depression properly so we can't medicate". I am rather highlighting the difficulties in medicating patients with mental health problems, particularly depression and bipolar disorder, as there is a complexity not found with such regularity in cases of fatigue and pain as you gave examples. How often is a patient given a pain medication only to find their senses heightened to the pain, rather than dulled? What is the frequency with which a patient given a medication to reduce blood pressure finds it rising? Not nearly as often as those with depression can have their symptoms worsened with medication, or, as I pointed out, a manic episode triggered in a bipolar patient who has not been diagnosed as such.

We should medicate, by all means - but in reference to the original post, we are looking at odds for some medications of more than 1 in 100, or 1 in 1000, and each individual response varies much more than if we were using morphine or aspirin or warfarin. Anecdotally speaking, to highlight the point that this may be used to our benefit in understanding depression, is the fact that my response to every SSRI I have been on (quite a few) I experience several days to a week of hypomania before having my depression drop suicidally low. If we could understand brain chemistry more, perhaps scientists could identify why me (and perhaps others) have this routine response to a certain type of depression medication, and not to others. Understanding nuances would help us better medicate.

As you see, I am not suggesting we stop medicating because we don't understand, simply that we aim to learn more to reduce the variance in responses that currently occurs with depressive medications that does not occur with most other areas (i.e. the medication provokes a response counter to the response that was intended)

Comment author: aletheianink 02 February 2014 01:21:41AM 0 points [-]

I think that the tricky thing is that a psychiatrist has to put statistics into perspective on two sides of the equation - both in regards to the medication, and then in regards to the diagnosis/presentation of the patient. In a nutshell, we diagnose patients based on their behaviour, not their brain chemistry and function, while we are using medication to treat their brain chemistry and function. We are not treating something that, in most cases, a doctor can see or quantify absolutely (in most instances doctors are not doing brain scans in order to medicate - I don't even think at this point in our understanding they do).

Looking at the side effects for many psychiatric medications, it is fairly clear that the side-effects are vast and for a huge number also include non-temporary worsening of symptoms, including risk of suicide. To me that indicates that we do not understand nearly enough about brain chemistry or the cause of mental illness to medicate with reason - as much of it is intuition and experience and guesswork as formal training.

In this link it notes that "Gjedde explains we don't really know what is wrong with people suffering from depression but looking at the symptoms we get a good idea of where the fault could lie within the brain". Furthermore, major theories such as that the serotonin causes depression are suggested to be simplistic and innacurate, so while we have an idea that using medication to affect serotonin levels can help depression, it doesn't mean that low serotonin levels are the cause. Those two articles are generally depression-specific, but considering that depression is probably the most studied mental illness (if not one of), if our understanding of that illness is vague, it seems likely that our understanding of other psychiatric illnesses are too (which is supported very much by the "we'll try this medication and see if it works" approach, as opposed to "you have a hole in your leg, we'll dose you up with morphine and you won't feel it as much").

In response to Bayesian Judo
Comment author: aletheianink 01 December 2013 06:14:07AM 0 points [-]

That was beautiful!

Comment author: aletheianink 01 December 2013 06:12:19AM 1 point [-]

I've read quite a few of the articles here, and something that seems commonly mentioned but never really acted upon is the idea of the rationality dojo. I understand that a key point in Eliezer's opinion is the in-person element, but looking at meetups it also seems like there are a lot more people talking on the forums than there are actually getting together in person.

Pattrismo wrote an excellent article on how LW is shiny distraction, but it seems like little hard action came of this. Has anyone discussed the idea of creating an online dojo, with specific exercises and required reading? I found (freyley's post on the topic)[http://lesswrong.com/lw/2w0/rationality_dojo/] but, again, nothing seemed to come of it except a few ideas. Would it be possible to create some sort of online course or thread? While the in-person meetups do seem like the best option, I'm sure there are many LWers who aren't near a meetup, or can't get to one at the arranged time and place, and a specific online dojo might be the answer to that?

Comment author: hyporational 01 December 2013 05:59:14AM 1 point [-]

Admitting you're wrong is not necessary for changing your mind. I think they're two different skills.

Upvoted for the first two thirds.

Comment author: aletheianink 01 December 2013 06:03:13AM 0 points [-]

Good point - I interchanged the two too readily.

Comment author: aletheianink 01 December 2013 05:53:01AM *  0 points [-]

I don't have the technical skills to do this, but I would suggest something like this:

  1. Find sources where you would find things of interest to you, if they were happening now.
  2. Create a tool (or script or something) to scrape their "events" page at regular intervals and then sorts that data, searching for keywords
  3. Have it then notify you in some context when something you like is mentioned.

This isn't foolproof (for example, it might say "Band X is the next Beatles!" if you've chosen Beatles ... but then you might find something you like). Pages like meetup, local ticketing outlets, facebook community pages, etc. are a good source. If you google about you might be able to find instructions for doing something like this.

There's also a website called www.ifttt.com which is essentially an "if this, then that" formula for the internet, but it only works for certain websites, and you need an account. It may serve your purposes, though - you could link it to twitter and get emails if given accounts mentioned the word "tour", "concert", "show" or any other relevant word. That's the closest tool that already exists that I can think of.

Comment author: aletheianink 01 December 2013 05:36:14AM 2 points [-]

I wish I lived in Leipzig! And probably also spoke German. This sounds awesome!

Comment author: dspeyer 30 November 2013 03:11:19PM 8 points [-]

I've had bad experiences using the Socratic method on people who are trying to win. I ask a question and they wander away from it to reiterate all of their points. And now I've used up my talking quota for a while.

On people who start out wanting to learn, it can be very effective.

Comment author: aletheianink 01 December 2013 05:32:55AM 0 points [-]

I agree. I think most people just want to talk at you, not with you, when they're determined to win, and very few people would ever follow a conversation the way Socrates' opponents do in Plato's works.

Comment author: aletheianink 01 December 2013 05:28:15AM 3 points [-]

I think this happens because it takes skill to accept being wrong. I know this has essentially been mentioned on LW before (my most recent reading was in MrMind's comment on the 5 Second Level), but I don't think most people have learnt that skill.

What we learn is that if we say "yes, I was wrong", others have then jumped on us, made fun of us or made an example of us - this starts when we're kids, or in school, where if we happen to be around teachers or parents with an inferiority complex, we've quickly learnt that it's better to be absolutely right or say nothing rather than be a little wrong.

We come here because we want to be, well, less wrong - and we're willing to admit we're wrong in order to be less so, so we're more likely to enter an argument with the genuine goal of coming out with a less wrong answer, rather than proving that our view is right. Most people want to be right, want to fit in, want to not make a mistake because most of us have learnt that being wrong = bad, and we don't want to be bad.

Comment author: ExaminedThought 28 November 2013 02:06:04AM 10 points [-]

I answered everything I could. I wish I could have put what my IQ is, but I've never taken an official test. I'm not sure I want to know what my IQ really is. If it's lower than I want, I think I'll feel inferior, envious, and generally frustrated that I can't do much to improve it.

Comment author: aletheianink 01 December 2013 12:55:18AM 0 points [-]

I don't know if this helps, but I felt the same way, and took the Mensa entrance test to find out my IQ. Turns out that they don't actually give you the results, just tell you if you've entered ... and at the moment, that's satisfied my desire to know without feeling unhappy it's not high enough.

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